Viagra and Cialis ads coming to an EHR near you. Let's hope no EHR vendor makes ads a required part of their EHR.
Tuesday, January 22, 2013
Wednesday, January 16, 2013
VA patient health record challenge
I absolutely love the crowd-source methodology for solving complex problems. Kudos to the VA for giving the ingenious developers of this country a chance to show off their vision for a usable patient health record. This challenge received over 200 entries, and has some fantastic design presentations.
Jump over to Github for more specifics on each design. The winner for best overall design (click picture for direct link):
Near and dear to our hearts; the winner for best medication design (click picture for direct link):
Simple, uncluttered, visual, and you can print a 1 page summary!
Monday, January 14, 2013
Drug approvals 2012
ASHP Puts together a nice list of drugs approved in 2012.
Lots of biologics and chemotherapeutic agents. Quadrivalent flu vaccine is cool and will keep us productive more days next year. Apixiban has potential as an anticoagulant, would be nice to get some folks off of warfarin if warranted and safer. Very few antimicrobials.
If you want the full list from the FDA, navigate to CenterWatch.
Tuesday, November 6, 2012
Meaningful Use Stage 2 Simplified for Us Pharmacy Folk: Part 5
In Part 1 we covered basic timelines and goals, in Part 2 we reviewed Core Objectives, Part 3 we reviewed Menu Objectives, and our Part 4 touched on clinical quality measures.
It is important to separate Meaningful Use from the ONC HIT certification criteria for EHR technology. Although there are many similar criteria in both, Meaningful Use focuses on how healthcare workers should use EHRs. ONC HIT criteria focus on the capabilities of the EHR, and what vendors have to build into the system they sell to health systems and clinics.
The 2014 ONC HIT Criteria attempt to parallel reporting criteria with Meaningful Use in addition to setting the quantity of certified EHR technology to meet each stage of Meaningful Use. Requirements for EHR technology coupled with new Core, Menu, and clinical quality measures ensures 2014 will be busy for most health systems.
In 2014 some criteria will remain the same, while others are modified, removed, or brand new. The following lists each criteria categorized respectively. Green are directly related to medication use and will likely be influenced by Informatics Pharmacists.
Unchanged criteria:
1. CPOE
2. Medication List
3. Med Allergy List
4. Authentication, access controls and authorization
5. Integrity
6. Incorporation of lab test results
7. Advanced Directives
8. Immunization information
9. Auto log off
10. Emergency Access
11. Accounting of disclosures
Modified criteria:
1. Vital signs, BMI, growth charts
2. Patient lists
3. Smoking status
4. Drug formulary checks
5. Patient reminders
Removed criteria:
1. Public health surveillance
2. Reportable laboratory rests and values/results
New criteria:
1. Calculation and Reporting
2. Safety-enhanced design (drug warnings, CDS, eMAR, ePrescribing included)
3. Quality design measures integration
Although many of us have or will have these technologies in place by 2014, accurate reporting will likely be our largest challenge. Many health systems are still learning to use EHRs, creating a plethora of incongruous and unnecessary orders, visits, notes, and results. I will be sifting through the mined data like the rest of you, trying to produce an accurate attestation for the folks at CMS.
You can review updated information at the healthit.gov website.
This concludes our direct summary of Stage 2 Meaningful Use and ONC HIT certification criteria. Thanks for reading and please feel free to post questions or comments.
Monday, October 29, 2012
Meaningful Use Stage 2 Simplified for Us Pharmacy Folk: Part 4
In Part 1 we covered basic timelines and goals, in Part 2 we reviewed Core Objectives. Part 3 reviewed Menu Objectives and our 4th installment will briefly review clinical quality measures.
The big year for Clinical Quality Measures (CQM) will be 2014. Due to the parallel requirements for ONC certified EHR technology during the year, it will be busy. Thank goodness we only have to attest for 3 months during 2014! CQMs are focused on conditions that contribute to morbidity or mortality. These coincide with many national public health priorities or common health disparities. Currently Eligible Hospitals must meet 100 %, or 15 of 15 measures. Stage 2 adds 14 new measures to the foray, but only requires 16 of the total 29 to be met. Many of you have implemented a slew of these already, albeit on paper or EHR.
Keep in mind many of these require workflow and process redesign as well as implementation within an EHR. Pharmacists are commonly involved in core measures surrounding medication use; now we get to use the Informatics knowledge to implement them in the EHR.
Here is the list (some broken out for clarity). Green are new for medication use in Stage 2.
1. Aspirin at Arrival: Acute MI patients who received aspirin within 24 hours before or after hospital arrival.
2. Discharge Instructions: Heart failure patients
3. ACEI or ARB for LVSD
4. ASA Prescribed at Discharge
5. Relievers for inpatient asthma
6. Corticosteroids for inpatient asthma
7. Initial ABX selection for CAP in immunocompetent patients
8. Blood Cultures performed in ER prior to first ABX dose
9. Beta blocker prescribed at discharge
10. Fibrinolytic Therapy within 30 min of hospital arrival
11. VTE Prophylaxis within 24h prior or 24 hours after surgery
12. Perioperative Beta blocker admin in surgery patients
13. Home Management Plan for Pediatric asthma caregiver
14. VTE Prophylaxis during Hospital Admission
15. ICU VTE Prophylaxis during Admission
16. VTE Patients with overlap of IV and warfarin therapy
17. VTE Patients receiving Heparin with Monitoring Protocols
18. VTE Discharge Instructions
19. Incidence of preventable VTE
20. VTE Prophylaxis in stroke patients
21. Antithrombotic therapy at discharge in Ischemic stroke patients
22. Anticoagulation therapy at discharge in Ischemic stroke patients with Afib/flutter
23. Thrombolytic Therapy within 3 hours of admission in acute ischemic stroke patients
24. Antithrombotic therapy by end of hospital day 2 in ischemic stroke patients
25. Statin medications written for discharged ischemic stroke patients with LDL > 100
26. Stroke Education
27. Infants 22 to 29 weeks gestation treated with surfactant within 2 hours of birth
28. Prophylactic ABX within 1 hour prior to surgical incision
29. Prophylactic ABX selection for surgical patients
30. Prophylactic ABX discontinued within 24 hours post surgery end (48h cardiac)
31. Statin prescribed at discharge for AMI patients
32. Pneumococcal Immunization prior to discharge
33. Influenza Immunization prior to discharge
34. ED Throughput
For updated information please visit the CMS section on CQMs. Next we will review Certified EHR Technology.
Tuesday, September 18, 2012
Meaningful Use Stage 2 Simplified for Us Pharmacy Folk: Part 3
In Part 1 we covered basic timelines and goals, in Part 2 we reviewed Core Objectives. Welcome to the third installment, where we will outline the Menu Objectives.
Stage 2 Meaningful Use provides a large update to the Menu Objectives when compared to Stage 1. In Stage 1, we only saw Advanced Directives as an objective. In Stage 2 we have a number of new additions, including a few relevant to Pharmacy Informatics. As mentioned in Part 2, Eligible Hospitals must meet 3 out of 6 for Meaningful Use. Those relevant to pharmacy include:
Progress Notes for more than 30 % of unique patients. While this might primarily be an objective for providers, pharmacists are also writing notes related to medication therapy. Common examples include anticoagulation or pharmacokinetic consults, as well as a number of items we will cover in Part 4 on Clinical Quality Measures. Informatics Pharmacists may be asked to help provide contextual tools to aid the clinical pharmacist in writing notes. The more targeted and meaningful notes we can write, the more likely we are to be accepted as members of the healthcare team. Informatics is an important platform for pharmacists to show others the benefits of an EHR.
ePrescribing in more than 10 % of discharge prescriptions. Informatics Pharmacists play a role in configuring and maintaining the medication database used by providers to create electronic prescriptions. Depending on the facility, they may own it entirely, or support it indirectly with another team. A more comprehensive and accurate medication ordering database will translate to safer prescriptions and better physician acceptance. Don't underestimate the importance of maintaining your medication libraries for prescribing use. It is the linchpin in the connection to the continuity of care and will come full circle if a patient comes back to your hospital.
Other objectives more unrelated to pharmacy include:
- Imaging results: more than 20 % are accessible using certified EHR technology
- Family histories are recorded in more than 20 % of patients
- Advanced directives are recorded for more than 50 % of patients 65 years or older
- Lab results are provided to providers for more than 20 % of patients
If you like charts, CMS provides a nifty comparison table for both core and menu objectives.
Thursday, September 13, 2012
ONC Dashboard on Health IT Adoption
The Office of the National Coordinator for Health IT has released a dashboard showing various adoption statistics. Lots of fun to play with, I recommend you give it a try.
Of note:
- Provider adoption is anywhere from 12 to 40 %. Rural providers have adopted quicker than small practices in general.
- Hospital adoption of Basic EHR (I will explain this in a future post) went from around 20% in 2010 to 35% in 2011.
- About 93% of community pharmacies are in the Surescripts network for ePrescribing.
Data based on Feb 2012 ONC Brief.
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